神经外科重症患者肺部感染多重耐药菌的危险因素分析

目的 调查神经外科重症患者合并肺部感染的病原菌分布及耐药情况,并分析其肺部多重耐药菌(MDRO)感染的危险因素.方法 回顾性分析187例伴有肺部感染的神经重症患者的临床资料、肺部病原菌分布和MDRO的耐药情况,并根据其痰培养病原菌是否为多重耐药菌将患者分为耐药菌组和非耐药菌组,分析神经重症伴肺部感染患者感染MDRO的危...

Analysis of risk factors for multiple drug resistant organism in neurocritical patients with pulmonary infections

Objective To investigate the distribution of pathogenic bacteria and drug resistance in neurocritical patients with pulmonary infections,and to analyze the risk factors of pulmonary infections with multiple drug resistant organism(MDRO).Methods The clinical data,distribution of pulmonary pathogens and MDRO resistance of 187 patients with severe neurological disease complicated with pulmonary infection were analyzed retrospectively.According to whether the pathogens in sputum culture were multi drug resistant bacteria,the patients were divided into drug-resistant bacteria group and non drug-resistant bacteria group,and the risk factors of MDRO infection in patients with severe neurological disease complicated with pneumonia were analyzed.Results There were 54 cases in non MDRO infection group and 133 cases in MDRO infection group.A total of 333 strains of pathogens were isolated,196 strains(58.85%)in MDRO group.Gram negative bacteria(73.98%)were the main pathogens,including Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa.The constituent ratio of MDRO from high to low was Acinetobacter baumannii,Staphylococcus aureus,Klebsiella pneumoniae and Pseudomonas aeruginosa.Univariate analysis showed that there were significant differences in neurosurgical intensive care unit(NSICU)stay,the lowest GCS score,ventilation time,the establishment of artificial airway,the time and type of antibacterial drug use,the combination of drugs,the use of carbapenems,and the use of glucocorticoids(all P<0.05).Multivariate logistic regression analysis showed that the increased of stay time in NSICU,time and types of antibiotics use contributes to risk of MDRO infection in neurocritical patients with pneumonia.Conclusions The infection rate of multidrug-resistant bacteria in the lungs of patients with severe neurological diseases is high,mainly gram-negative bacilli.Shortening hospital stay,strengthening the rational use of antibiotics and reducing the use time and types of antibiotics are of great significance to control multidrug-resistant bacterial infection.Enhanced recovery after surgery(ERAS)may be a favorable measure.